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10-0797 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00000797 Property Address: .53870 AVENIDA CORTEZ APN: 774-.142-007-18 -000000- Application description: MECHANICAL. Property Zoning: COVE RESIDENTIAL Application valuation: 8930 Tit!t °f 4 Q" Appf ntv- Architect or Engineer: ------------------- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty�of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the; Business and Professionals Code, and my License is in full force and effect. License_ Class: C20 License No:: 595145 Date: �7/7Yld Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the.Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the. permit to file a signed statement that he or-she:is licensed pursuant.to.the provisions of the Contractor's -State License Law (Chapter 9 (commencing with Section ,7000) of Division;3,of the Business and Professions Code) or that he or'she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031:5 by any applicant for a permit subjects the applicant to acivil penalty of not more than five hundred dollars (5500).: (_ 1 l,.as owner of, the property, or my employees with wages: as their sole compensation, will do the work, and the structure. is not intended or offered.for sale (Sec. 7044„ Business and Professions Code: The Contractors' State License Lew does.not:apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements. are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale,). (_ 1 1, as owner of the property, am :exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License. Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1 _ I 1 am exempt under Sec. , BAP.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of�the workJorrwhich this permit. is'issued '(Sec. 3097, Civ. C.I. Lender's Name: Lender's' Address: LQPERMrT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/25/10 Owner: ANDERSON JAZMIN 53870 AVENIDA CORTEZ LA QUINTA; CA 9225 ( D d Contractor: Q2 J L 2010 DCS HEATING/AIR CO I ONO' C 72078 CORPORATE W , THOUSAND PALMS., C 922'7�OFLAQUWA (760) 343-5566 A MOE Lic. No.:.595145 ------------------ WORKER'S COMPENSATION DECLARATION 1 hereby affirm under -penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the,work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the,work-for which'.thispermiris issued. My workers' compensation insurance carrier and policy number are: Carrier HARTFORD INS Policy Number 72WECLS7131 _ I certify that, in:the performance+of"the work for which this permit is issued, Ishall not employ any person in any: manner'so as to become°subject tothe workers' compensation laws of California, and agree that, if I should become subject,to the workers' compensation provisions of Section e3700 of the Labor Code, II shall forthwiithh,ccoomply with those provisions. Date: � d Applicant: �/L�-, i r''L. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE.COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF?HELABORCODE, INTEREST, AND. ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application isherebymade to -the Director of Building and Safety for a permit.subject-to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuam;ao.any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify'and holdharmlessthe City of La Ouinta, its officers„agents and employees for any act or omission related.to the work being performed under, or following.issuance of this permit. 2.. Any permitissued;as-a result of this application becomes null and void if work is not.commenced within 160 days from date of issuanceof such permit, or cessation of work for 180 days will subject permit to cancellation. I- certify that.l have read this application and state.that the above information,is correct. I agree to comply with all city and county ordinances and state laws relating to building' construction, and hereby authorize representatives of this county to enter upon the above-mentioned property r inspection purposes. Date: �"S�d Signature (Applicant or Agent): Application Number . . . . 10-00000797 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 2/21/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 EA MECH.B/C >3-15HP/>100K-500KBTU 16.50 Special Notes and Comments INSTALL (1) 4 TON 15 SEER COMPLETE HEAT PUMP SYSTEM AS REPLACEMENT. 2007 CODES. Other Fees . . . . . . . . . BLDG STD, ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 40.50 .00 .00 40.50 Plan Check Total 10.13 .00 .0.0 1.0.13 Other Fee Total 1.00 .00 .00 1.00 Grand Total 51.63 .00 .00 51.63 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlteradons CF -IR -ALT -HVAC Climate Zones 10 to 15 SiteAddress: C3 Enforcement Agency: Date: �2 Permit #: J Conditioned Floor E ui ment.T el List -Minimum EfficienCY2 Duct insulation requirement Area Thermostat O Packaged Unit ® Furnace ❑ AFUE ❑ COP Over 40 ft of ducts added or Setback ® Indoor Coil IZSEER__L57- ❑ HSPF replaced in anconditioned space ❑ R 6 (CZ 10-13) Served by system 136tcl sf (/f not already present, must be 0 Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) installed) ❑ Other 1. Equipment' Type: Choose the equipment being installed, if more than one system, use another CF -1 R -ALT -HVAC for each system. 2. Minimum Equipment Efciencies: 13 SEER, 78%AFUE, 7.7HSPFfor typicalresidential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a,copy given to the, homeowner. At final, the inspector verifies that the work listed on this. form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand,filled CF-411&allowed) are filled out and signed. Beginnin ,October 1, 2010 a registered copy of the CF -IR and CF=6R shall also be onsite for final inspection. ® 1. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for splitsystems) MECH- 25 -HERS CF -4R forms: MECH- 21 and fors lits stems MECH-25 • Condenser Coil and,/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH-'25-HERS • Indoor Coil and/or CF -4R forms: MECH- 21 and (for split systems) MEC11125 • Furnace For Split Systems: Duct leakage < 15 percent, RC, CCA >,300. CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if - f❑ 01. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet irrunconditioned space, or ❑ 3. Existing ducts stems, are constructed, insulated or sealed with, asbestos ❑ 2. New HVAC System Required Forms: • Cut in or Changeout with new ducts: (all new ducting nd all CF-6R:forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS CF -411 forms: MECH 20-, and (for:split systems)MECH-22, and MECH 25 new equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -611 forms: MECH-04; MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -411 forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 Iinearfeet of duct in unconditioned space. For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems, constructed, insulated or sealed with asbestos. Contractor (Documentation. Author's /Responsible Designer's Declaration Statement) • I.certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility. for the design identified on this Certificate of Compliance. I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6. of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans ands ifiications submitted to the enforcement agency for approval with the, unnitapplication. Name: G4 Signature: 1 Company: � � � � Date: 7ddress:�7 / w License: `1551 �f 7 D l V" D City/State/Zip: d 11W 5 C-4 er�;t.-7 Phone: 2008 Residential Compliance Forms March 20 Bin # 1 City Of La Q[uinta =Building 8r Safety Dlvislon P.O. Box 1.504, 78495 Calle Tampico la Qldnta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Pem#t # Project Address: 5-3,fr7r Ave. Owner's Name: A. P. Number: Address: S3 $Tri Legal.Description: City,, ST, Zip: Contractor: �%C5 L 4 L- y�i! t�i«.1'diw,; Telephone: � Address: 7)-,,-7 �� �q VV/ 5�t�G( Project Description: City, ST, Zip: G Ct 227 6 S S S�G rn Telephone: 7%Cl-3 -55w,'15; State Lic. # : 4S ,City Lie. #; 0 10,F& Arch., Engr., Designer. Ccs Address: City, ST,:Zip: Telephone: y State Lic. #: Name of Contact Person: Construction Type: Occupancy: Projeettype (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: EstimatedValue of Project 19" q G• APPLICANT: DO NOT WRITE BELOW THIS LINE Submittal Req'd Recd TRACIMG PERMIT FEES Plan Sets Plan Check submitted. Item Amount Structural CalcL Reviewed, ready for corrections Plan Check Deposit. Truss Calcs. Called Contact Person Plan Check Balance Tide 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan r Review, ready for eorrectionsiissue Electrical Subcontactor last Called Contact Person Plumbing Grant Deed Pians picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for correcdons/issue Developer Impact Fee. Planning Approval Called Contact Person AXP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees